• Posted May 1, 2023

One-Time Endoscopic Treatment Might Replace Insulin for People With Type 2 Diabetes

Could a one-hour procedure that involves zapping a part of the intestines mean no more insulin for millions of folks with type 2 diabetes?

Maybe, according to a small study scheduled for presentation next week at the Digestive Disease Week meeting in Chicago.

The new minimally invasive procedure used controlled electrical pulses to change the lining of the first part of the small intestine (the duodenum). This improved blood sugar control and eliminated the need for insulin for at least one year among people with type 2 diabetes, the researchers said.

People with type 2 diabetes don't use the insulin in their body properly, and as a result, their blood sugar, or glucose, can build up. Some of these patients will need to take synthetic insulin to keep their blood sugar in check.

"This might be a game changer in the management of type 2 diabetes," said study co-author Dr. Jacques Bergman, a professor of gastrointestinal endoscopy at Amsterdam University Medical Center in the Netherlands. A single outpatient intervention "was suggested to have a pretty long therapeutic effect,"he added during a media briefing.

Exactly how the procedure works isn't fully understood, but researchers believe it changes the tissue in the intestine to improve insulin resistance or how the body responds to insulin.

"This technique is disease-modifying as it goes to the root cause of type 2 diabetes and tackles insulin resistance as opposed to drug therapy, which is at best disease-controlling, and its effect is immediately gone if a person stops taking the medication,"Bergman explained.

The study was funded by Endogenex, a Minnesota-based company that owns the technology used for the procedure.

For the study, 14 people with type 2 diabetes underwent the investigational procedure, which is done via endoscopy. That means doctors inserted a flexible, lighted tube down the throat to the digestive region. All had been taking insulin.

Everyone went home the same day as the surgery. They followed a calorie-controlled liquid diet for two weeks after which they started taking semaglutide, a diabetes medicine that regulates blood sugar levels. (This is the same medication used for weight loss under the brand name Ozempic.)

Of these, 12 people kept their blood sugar in the normal range for a year without the need for insulin, the study showed.

Semaglutide may help people with type 2 diabetes avoid insulin, but this usually occurs in just 20% of patients, so researchers don't think the insulin-sparing effect was due to the drug.

In addition, people in the study had a 50% reduction in liver fat. Excess fat in the liver makes it harder to control blood sugar.

A larger study is set to begin within the next three months, Bergman said. If this research pans out, the procedure may be an option for people with type 2 diabetes in three to five years, he noted.

Diabetes affects 37 million Americans, 90% of whom have type 2 diabetes. This is the form of the disease linked to obesity. Although most commonly diagnosed after age 45, doctors are seeing more cases in children and young adults, the authors noted. Disease-controlling medications, including insulin, can be expensive and have side effects.

Dr. Pooja Singhal, a gastroenterologist and director of women's digestive health at SSM Health St. Anthony Hospital in Oklahoma City, said the new approach shows promise.

"The procedure has a lot of potential and could be groundbreaking because it is disease-modifying as opposed to disease-controlling,"she said.

However, more research in larger groups of people is needed to draw any firm conclusions about what role this procedure will play in type 2 diabetes, she said.

The surgery's effect on liver fat is also significant. "This could be very exciting in liver disease, too," Singhal said. "Nonalcoholic fatty liver disease will be the No. 1 cause of cirrhosis or severe liver scarring in coming years."

The findings are scheduled for presentation Tuesday, May 9. Research presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

More information

The American Diabetes Association offers more on type 2 diabetes treatment.

SOURCES: Jacques Bergman, MD, PhD, professor, gastrointestinal endoscopy, Amsterdam University Medical Center, the Netherlands; Pooja Singhal, MD, gastroenterologist, director, women's digestive health, SSM Health, St. Anthony Hospital, Oklahoma City, Okla.; presentation, Digestive Disease Week, Chicago, May 6 to 9, 2023